Massachusetts State Seal An official website of the Commonwealth of Massachusetts Here's how you know

Official websites use .mass.gov

A .mass.gov website belongs to an official government organization in Massachusetts.

Secure websites use HTTPS

A lock icon or https:// means you've safely connected to the official website. Share sensitive information only on official, secure websites.

Skip to main content

PERAC General Membership Forms

Skip table of contents
You skipped the table of contents section.

Member Benefit Forms

Application for Reinstatement to Service, Open PDF file, 111.2 KB (English, PDF 111.2 KB)
Beneficiary Change Form, Open PDF file, 419.67 KB (English, PDF 419.67 KB)
Beneficiary Selection Form, Open PDF file, 550.17 KB (English, PDF 550.17 KB)
Beneficiary Selection Form (Option D form), Open PDF file, 426.77 KB (English, PDF 426.77 KB)
Disability Application Glossary of Terms, Open PDF file, 126.97 KB (English, PDF 126.97 KB)
Disability Retiree Earned Income Worksheet, Open PDF file, 231.28 KB (English, PDF 231.28 KB)
Disability Retirement Application, Open PDF file, 445.85 KB (English, PDF 445.85 KB)
Disability Retirement Benefits for Veterans, Open PDF file, 104.73 KB (English, PDF 104.73 KB)
Instructions for Submitting the Annual Statement of Earned Income, Open PDF file, 689.79 KB (English, PDF 689.79 KB)
New Member Enrollment Form, Open PDF file, 458.14 KB (English, PDF 458.14 KB)
Pre-Tax Rollover Form, Open PDF file, 71.28 KB (English, PDF 71.28 KB)
Refund Form (Member), Open PDF file, 288.15 KB (English, PDF 288.15 KB)
Retirement Application (voluntary superannuation), Open PDF file, 428.67 KB (English, PDF 428.67 KB)
Retirement Option Selection Form, Open PDF file, 627.6 KB (English, PDF 627.6 KB)
Special Tax Notice Regarding Lump Sum Distributions, Open PDF file, 163.84 KB (English, PDF 163.84 KB)
Veterans' Buyback Form, Open PDF file, 488.87 KB (English, PDF 488.87 KB)

Survivor Benefit Forms

Application for Member Survivor Benefits, Open PDF file, 484.87 KB (English, PDF 484.87 KB)
Notice of Election of Benefits under 12(2)(d), Open PDF file, 363.84 KB (English, PDF 363.84 KB)
Refund Form (Beneficiary), Open PDF file, 206.49 KB (English, PDF 206.49 KB)
Spousal Affidavit to Determine Benefit Eligibility, Open PDF file, 431.97 KB (English, PDF 431.97 KB)
Spousal Notice of Election of Benefits, Open PDF file, 448.48 KB (English, PDF 448.48 KB)

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.
Feedback